本文關鍵詞：“健脾通絡湯”治療慢性萎縮性胃炎脾胃虛弱證的臨床療效及安全性研究　出處：《北京中醫(yī)藥大學》2017年碩士論文　論文類型：學位論文

  更多相關文章： 安全性研究 健脾通絡湯 療效觀察 慢性萎縮性胃炎 脾胃虛弱證

【摘要】：研究背景慢性萎縮性胃炎屬于胃癌前疾病,是胃癌發(fā)生的重要環(huán)節(jié)之一。慢性萎縮性胃炎在老年人患病率高,且發(fā)病年齡趨于年輕化,一般認為其與幽門螺旋桿菌感染、非甾體類藥物使用、不良的生活習慣、十二指腸反流、免疫因素等密切相關。病理活檢是確診慢性萎縮性胃炎的金標準。目前西醫(yī)治療方式包括根除幽門螺桿菌治療、對癥治療、十二指腸胃反流的治療以及內鏡下手術治療。治療效果不甚理想,復發(fā)率高,癥狀易反復,藥物副作用多等。中醫(yī)在治療慢性萎縮性胃炎方面經驗豐富,具有明顯的優(yōu)勢與特色,表現在改善癥狀、逆轉胃黏膜腺體萎縮、腸化及不典型增生,延緩或阻止病情進展、提高患者的生存質量、防止癌變等方面,且安全可靠、不良反應較少。研究目的本研究以導師多年的臨床經驗總結為基礎,觀察導師經驗方"健脾通絡湯"對慢性萎縮性胃炎的臨床療效及安全性。研究內容本論文分為文獻綜述和臨床研究兩部分:第一部分文獻綜述回顧總結近些年關于CAG的現代醫(yī)學研究進展和中醫(yī)藥研究現狀。慢性萎縮性胃炎屬于中醫(yī)的"痞滿"、"胃脘痛"、"胃痞"等范疇,以"痞、脹、痛"為三大主癥。本病主要病因病機為脾胃虛弱,寒、痰、濕、熱等邪困擾脾胃,阻滯氣機,脾胃氣機升降失司,或脾胃氣陰兩虛,胃絡失養(yǎng),久則痰瘀毒邪深入胃絡所致。病性總屬本虛標實、虛實夾雜之證。中醫(yī)的診斷以宏觀辨證和微觀辨證結合,治療以辨證論治、專方專藥等治療為主,將胃鏡與辨證結合,延伸四診內容。西醫(yī)治療存在局限性,對于病理的逆轉尚無確切的解決方案。第二部分臨床觀察研究方法收集慢性萎縮性胃炎且中醫(yī)辨證為脾胃虛弱證患者,共納入144例,予慢性萎縮性胃炎脾胃虛弱證的患者導師經驗方"健脾通絡湯"口服治療,連續(xù)服藥12周,于第0、2、4、6、8、10及12周由研究者填寫調查表。療程結束后行胃鏡及胃黏膜病理組織學檢查,進行療效評價。同時對血常規(guī)、肝腎功能及心電圖等安全性指標進行評價。計量資料使用T檢驗,以均數±標準差表示,計數資料使用χ2檢驗,等級資料應用秩和檢驗。應用SPSS21.0統(tǒng)計分析系統(tǒng)進行本次試驗研究所有的統(tǒng)計計算分析。研究結果"健脾通絡湯"對慢性萎縮性胃炎脾胃虛弱證的療效顯著,其治療的總有效率為88.19%,其中痊愈率為9.03%,顯效率為39.58%,有效率為39.58%�？筛纳莆葛つさ牟±頎顟B(tài),在一定程度上逆轉腺體萎縮、腸化和異型增生,其中:胃竇部萎縮治療的總有效率為82.76%,腸化生治療的總有效率為86.14%,異型增生的總有效率為100%,慢性炎癥的總有效率為64.42%;胃角部萎縮治療的總有效率為78.95%,腸化生治療的總有效率為75.00%,異型增生的總有效率為100%,慢性炎癥的總有效率為51.11%;胃體部位萎縮的總有效率為88.24%,腸上皮化生的總有效率為58.33%,異型增生的總有效率為100%,慢性炎癥的總有效率為45.65%。治療期間患者無不良反應發(fā)生,血常規(guī)、肝功能、腎功能指標均在正常值范圍內,心電圖檢查與治療前無差異,安全級別1級。研究結論:"健脾通絡湯"在治療脾胃虛弱證慢性萎縮性胃炎效果明顯,可迅速改善患者臨床胃脘癥狀,對萎縮、腸化及異型增生均有逆轉作用,且安全可靠,無不良反應發(fā)生。
[Abstract]:On the background of chronic atrophic gastritis to gastric precancerous disease, is one of the important link of gastric cancer. Chronic atrophic gastritis in the elderly high prevalence rate, and the incidence in younger age, generally considered the infection with Helicobacter pylori, non steroidal drug use, bad habits, duodenal reflux, immune factors closely related. Biopsy is the gold standard for diagnosis of chronic atrophic gastritis. The western medicine treatment includes Helicobacter pylori eradication therapy, symptomatic treatment, twelve refers to the treatment of surgery and endoscopic gastric reflux. The therapeutic effect is not ideal, high recurrence rate, the symptoms of easy relapse, the side effects of the drug. Many Chinese in the treatment of chronic atrophic gastritis with rich experience, has obvious advantages and characteristics, in improving symptoms, reversal of gastric mucosa gland atrophy, intestinal metaplasia and atypical hyperplasia, delay or prevent disease Progress, improve the quality of life of patients, prevent cancer and other aspects, and it is safe and reliable, less adverse reaction. The purpose of this study is to summarize the clinical experience of tutor based on tutor experience "Jianpi Tongluo Decoction" clinical efficacy and safety of chronic atrophic gastritis. The research content of this paper is divided into two parts literature review and clinical research: the first part is literature review summary in recent years modern medical studies on the progress of CAG and traditional Chinese medicine research. Chronic atrophic gastritis belongs to Chinese medicine, "fullness", "stomachache", "Weipi" and so on, "swelling, swelling, pain" as the three main symptoms. The main pathogenesis is weakness of the spleen and stomach, cold, wet, phlegm, heat evil stomach distress, stagnation of Qi, spleen and stomach qi dysfunction, or spleen qi and yin deficiency, stomach meridian dystrophy, long the phlegm and blood stasis toxin into stomach meridian disease caused. The total of this standard is false, false is mixed The diagnosis of Chinese medicine syndrome. In macro and micro differentiation combined with syndrome differentiation, treatment based on syndrome differentiation, specific drug treatment, combination of gastroscope and syndrome differentiation, extended diagnostic content. The limitations of Western medicine treatment, solution for pathological reversal. In the second part, there is no precise clinical observation research methods of chronic atrophy gastritis and TCM for patients with spleen stomach deficiency, a total of 144 patients were enrolled, patients with tutor experience "to the chronic atrophic gastritis of spleen stomach deficiency of Jianpi Tongluo Decoction oral treatment, medication for 12 weeks and 12 weeks in the 0,2,4,6,8,10 survey by researchers. In the end of the treatment after gastroscopy and gastric mucosal histopathology. To evaluate the curative effect. At the same time to evaluate the blood routine, liver and kidney function and ECG and other safety indicators. Using T test measurement data, the mean standard deviation of that the 2 test was used for count data, etc. Grade data using rank sum test. This test studied all the statistical analysis using SPSS21.0 statistical analysis system. The results of the study "effect of Jianpi Tongluo Decoction on chronic atrophic gastritis of spleen stomach deficiency significantly, the total effective rate of treatment was 88.19%, the cure rate was 9.03%, the effective rate was 39.58%, efficiency for 39.58%. can improve the pathological state of gastric mucosa, to a certain extent, reverse the gland atrophy, intestinal metaplasia and dysplasia, including: gastric antrum atrophy treatment the total effective rate was 82.76%, the treatment of intestinal metaplasia of the total effective rate was 86.14%, abnormal hyperplasia of the total effective rate was 100%, the total efficiency of chronic inflammation 64.42%; stomachcorner atrophy treatment the total effective rate was 78.95%, the treatment of intestinal metaplasia dysplasia, the total effective rate was 75%, the total effective rate was 100%, chronic inflammation of the total efficiency of 51.11%; gastric body atrophy of the total efficiency of 88.24 %, intestinal metaplasia dysplasia, the total effective rate was 58.33%, the total effective rate was 100%, chronic inflammation of the total efficiency of 45.65%. during the treatment of patients with no adverse reactions, blood routine, liver function, renal function indexes were in the normal range, electrocardiogram and no difference before treatment, security level 1 conclusions: "Jianpi Tongluo Decoction" in the treatment of spleen stomach deficiency syndrome of chronic atrophic gastritis is obvious, it can rapidly improve the clinical symptoms of patients with stomach, atrophy, intestinal metaplasia and dysplasia were reversed, and it is safe and reliable, no adverse reaction.

【學位授予單位】：北京中醫(yī)藥大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R259

【參考文獻】

相關期刊論文 前10條

1 王利軍;李廣琦;;“溫通針法”治療脾胃虛寒型萎縮性胃炎臨床療效觀察[J];中國針灸;2017年02期

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本文編號：1368676